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'Do not turn into the "Pain Police"'


Student Nurse Helen Farmer uses her recent knowledge and evidence to support advocating a patient’s concern over pain.

This week I encountered a very young patient who reported that she was in significant pain, despite being up to date with several different prescribed analgesics.

On reporting this to the nurse in charge and again later at handover, I was surprised to find that the nurse suggested that the patient’s pain was not as bad as the patient was maintaining. The nurse discussed with me what she considered typical behaviours of people who were in severe pain. I listened and absorbed the information. However, I found this reasoning difficult to accept despite the nurse’s many years of experience.

I drew on my recent lectures on the “concept of total pain” and how other factors can directly impact on pain. I went back to my patient and had a chat with her; I was able to establish some factors which may have increased her pain levels. These other factors included fear of disbelief regarding her pain, being away from home, missing out on her studies, not being prescribed her regular medications for her Irritable Bowel Syndrome (IBS). Armed with my new information which relates to the concept of “total pain”, we made a plan. We discussed mitigation for studies, reassurance that she would go home soon and that her family could visit and with the nurse’s agreement, I asked the doctor if she could prescribe the patient’s usual IBS medication. I think my patient felt a sense of relief following this.

Strangely enough, the following day, my patient’s pain had reduced to a manageable level; she was smiling and even went home.

Whilst I do not take credit for this change in pain, I believe my actions had an impact. I stood by my training, used it as a tool and continued to act as an advocate for my patient. I recall a university lecturer telling us not to turn into the “Pain Police” - referring to not judging pain you cannot feel for yourself. I remember laughing at this phrase. However, I believe my patient benefited from it this week.

Staying strong when others may disagree with you is something I have experienced this week. I was concerned how my different opinion may have affected my relationship with the nurse. I maintained my position and expressed an evidence-based opinion politely, whist acting as an advocate for the patient. A positive outcome all round!

Helen Farmer is a student nurse at University of Worcester, currently on placement on a Women’s Health Unit.


Readers' comments (5)

  • Little One

    I completely agree, as students are we not taught "Pain is whatever the experiencing person says it is, existing whenever he says it does" [McCaffery, 1968], and yet how many of us look at a patient and say "Oh he's faking it" or "They're exagerrating" or "They've had all their pain killers they can't possibly be in pain anymore"? It is not fair on the patient.

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  • An inspirational article where Helen seems to have hit the nail fair and square on its head.

    I am always shocked when others believe they have the power to judge the feelings or level of pain another is suffering and this is often pronounced with some sort of smug arrogance as if they derived some satisfaction from attempting to show off their 'knowledge and experience', which confident nurses and doctors do not feel the need to do. It may be because of a feeling of powerlessness to help as they have already given all the medication, or they cannot go and give their support to the patient for various reasons such as time constraints, lack of adequate resources, lack of interpersonal skills, fatigue, stress or even plain laziness, preferring to use the time to chat to their colleagues instead!

    Part of good care is giving the patient the attention they need and not just handing out medication. Pain is often worse if individuals are just left to focus all their attention on their pain and all their other worries and concerns whereas excellent communication skills and attention, as described in the article, will go a long way in helping to alleviating it.

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  • Adam Roxby

    Hello Helen

    Another brilliant article. I always enjoy seeing a new one apear in my news feed.

    Pain is always a difficult subject but I think you handeled it very well and was the perfect advocate for your patient.

    Well done.

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  • As a student nurse and also someone who suffers with chronic pain I am filled with hope to find articles like this. Over the years of trying to find a cause for my pain, I have been judged and ignored in hospitals so many times. This is one of the reasons I wanted to become a nurse as I know what a difference a nurse like Helen makes.
    I had a nurse like Helen who helped to instigate a change in approach to my treatment and after years of being in debilitating pain, I have been diagnosed and found a medication that allows me to have a life.

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  • Wow! If I wrote a reflection like that, I would be criticised and marked down for raising contentious issues such as recognising the inappropriate behaviour of healthcare professionals!!!!!

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